IATROGENIC FEMORAL VEN THROMBOSIS DEVELOPING IN A 6 MONTHS INFANT AFTER MULTIPLE INTERVENTION

Yıl 2020, , 52 - 54, 16.01.2020

Murat Günday , Özlem Kayacık Günday

https://doi.org/10.18229/kocatepetip.465864

Öz

Hospitalized infants and children sometimes require long-term parenteral treatment. Therefore, patients need to insert a catheter from the central veins. Various complications due to catheter may occur. In this case report, a 6-month-old female baby was operated due to the diagnosis of hydrocephalus due to choroid plexus papilloma. Anesthesia was attempted to insert a venous catheter from the right groin. After more than one puncture, the baby’s leg was bruised. Femoral vein thrombosis was detected. Low molecular weight heparin treatment was started subcutaneously. The bruising on his leg improved. As a result, multiple application accelerates the endothelial damage and subsequent thrombus formation. Therefore, infants should be punctured under ultrasound and avoiding multiple interventions.

Anahtar Kelimeler

Iatrogenic, thrombosis, multiple intervention

Çoklu Girişim Sonrası Altı Aylık Bebekte Gelişen İatrojenik Femoral Ven Trombozu

Öz

Hastanede yatan bebek ve çocuklarda bazen uzun süreli parenteral tedavi ihtiyacı olur. Bu nedenle hastalarda santral venlerden kateter takılması gerekir. Katetere bağlı çeşitli komplikasyonlar meydana gelebilir. Bu olgu sunumunda, 6 aylık kız bebek, koroid pleksus papillomuna bağlı hidrosefali tanısı nedeniyle operasyona alındı. Anestezi tarafından sağ kasıktan venöz kateter takılmaya çalışıldı. Birden fazla yapılan ponksiyon sonrası bebeğin bacağında morarma, bacakta tümden şişlik gelişmesi nedeniyle yoğun bakıma alındı. Yapılan tetkiklerde femoral ven trombozu saptandı. Tedavide düşük molekül ağırlıklı heparin tedavisi subkutan olarak başlandı. Takiplerinde bacaktaki morarma düzeldi. Sonuç olarak, çoklu uygulama endotel hasarı ve sonrasında trombüs oluşumunu hızlandırır. Bu nedenle, infantlarda mutlaka ultrason altında ve çoklu girişimden kaçınarak ponksiyon yapılmalıdır.

Anahtar Kelimeler

İatrojenik, Tromboz, Çoklu Girişim

Kaynakça

• 1. Gibson C, Connolly BL, Moineddin R, Mahant S, Filipescu D, Amaral JG. Peripherally inserted central catheters: use at a tertiary care pediatric center. J Vasc Interv Radiol 2013; 24(9): 1323–31
• 2.Jalota L, Aryal MR, Jain S. Iatrogenic venous air embolism from central femoral vein catheterisation. BMJ Case Rep. 2013:13;2013.
• 3.Wang W1, Moon E, Spain J. Balloon-assisted N-butyl-2-cyanoacrylate closure of an iatrogenic femoral arteriovenous fistula. Vasc Endovascular Surg. 2013;47(2):131-4.
• 4.Le TB, Kim JH, Park KM, Jeon YS, Hong KC, Cho SG Iatrogenic Iliofemoral Vein Dissection: A Rare Complication of Femoral Artery Puncture. Vasc Endovascular Surg. 2018;52(6):482-5.
• 5.Papadakis M, Zirngibl H, Floros N. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration. Ann Vasc Surg. 2016;34:269.e13-5.
• 6. Revel-Vilk S, Ergaz Z. Diagnosis and management of central-line–associated thrombosis in newborns and infants. Semin Fetal Neonatal Med. 2011;16(6):340-4.
• 7.Gutierrez JA, Bagatell R, Samson MP, Theodorou AA, Berg RA. Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis Crit Care Med. 2003; 31(1):80–3.
• 8. Andrew M, Monagle PT, Brooker L: Thromboembolic Complications During Infancy and Childhood. First Edition. Hamilton, Ontario, Decker, 2000
• 9. Nuss R, Hays T, Manco-Johnson M. Childhood thrombosis. Pediatrics. 1995;96:291-4.
• 10. Venkataraman S, Thompson A, Orr R: Femoral vascular catheterization in critically ill infants and children. Clin Pediatr 1997; 36(6): 311–9.
• 11. Talbott GA, Winters WD, Bratton SL, O'Rourke PP. A prospective study of femoral catheter-related thrombosis in children. Arch Pediatr Adolesc Med 1995; 149(3):288–91.
• 12. Monagle P, Michelson AD, Bovill E, Andrew M. Antithrombotic therapy in children. Chest. 2001;119(1 Suppl):344S-370S.
• 13.Kahn SR, Comerota AJ, Cushman M, Evans NS, Ginsberg JS, Goldenberg NA, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014;130(18):1636-61.
• 14. Goldenberg NA, Durham JD, Knapp-Clevenger R, Manco-Johnson MJ.. A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood 2007 110(1):45-53.
• 15.Gaballah M, Shi J, Kukreja K, Raffini L, Tarango C, Keller M, et al. Endovascular Thrombolysis in the Management of Iliofemoral Thrombosis in Children: A Multi-Institutional Experience. J Vasc Interv Radiol. 2016;27(4):524-30.